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The Impact of Prior Laparotomy and Intra-abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma

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Abstract

Background

Early recognition of bowel and mesenteric injury following blunt abdominal trauma remains difficult. We hypothesized that patients with intra-abdominal adhesions from prior laparotomy would be subjected to visceral sheering deceleration forces and increased risk for bowel and mesenteric injury following blunt abdominal trauma.

Methods

We performed a multicenter retrospective cohort analysis of 267 consecutive adult trauma patients who underwent operative exploration following moderate-critical (abdominal injury score 2–5) blunt abdominal trauma, comparing patients with prior laparotomy (n = 31) to patients with no prior laparotomy (n = 236). Multivariable regression was performed to identify predictors of bowel or mesenteric injury.

Results

There were no significant differences between groups for injury severity scores or findings on abdominal ultrasound, diagnostic peritoneal aspirate/lavage, pelvic radiography, or preoperative CT scan. The prior laparotomy cohort had greater incidence of full thickness bowel injury (26 vs. 9%, p = 0.010) and mesenteric injury (61 vs. 31%, p = 0.001). The proportion of bowel and mesenteric injuries occurring at the ligament of Treitz or ileocecal region was greater in the no prior laparotomy group (52 vs. 25%, p = 0.003). Prior laparotomy was an independent predictor of bowel or mesenteric injury (OR 5.1, 95% CI 1.6–16.8) along with prior abdominal inflammation and free fluid without solid organ injury (model AUC: 0.81, 95% CI 0.74–0.88).

Conclusions

Patients with a prior laparotomy are at increased risk for bowel and mesenteric injury following blunt abdominal trauma. The distribution of bowel and mesenteric injuries among patients with no prior laparotomy favors embryologic transition points tethering free intraperitoneal structures to the retroperitoneum.

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Acknowledgements

This work was supported in part by Grants R01 GM113945-01 (PAE), R01 GM105893-01A1 (AMM), and P50 GM111152–01 (FAM, SCB, PAE, AMM) awarded by the National Institute of General Medical Sciences (NIGMS). TJL was supported by a post-graduate training grant (T32 GM-008721) in burns, trauma and perioperative injury by NIGMS. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, University of Florida Health, 1600 SW Archer Road, Box 100108, Gainesville, FL, 32610, USA

    Tyler J. Loftus, Martin D. Rosenthal, Chasen A. Croft, R. Stephen Smith, Frederick A. Moore, Scott C. Brakenridge, Philip A. Efron & Alicia M. Mohr

  2. Sepsis and Critical Illness Research Center, University of Florida Health, Gainesville, FL, USA

    Tyler J. Loftus, Martin D. Rosenthal, Frederick A. Moore, Scott C. Brakenridge, Philip A. Efron & Alicia M. Mohr

  3. Department of Surgery, Florida Atlantic University, Boca Raton, FL, USA

    Megan L. Morrow, Lawrence Lottenberg & Robert Borrego

  4. Department of Surgery, St. Mary’s Medical Center, West Palm Beach, FL, USA

    Megan L. Morrow, Lawrence Lottenberg & Robert Borrego

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  1. Tyler J. Loftus
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  2. Megan L. Morrow
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Correspondence to Alicia M. Mohr.

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Loftus, T.J., Morrow, M.L., Lottenberg, L. et al. The Impact of Prior Laparotomy and Intra-abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma. World J Surg 43, 457–465 (2019). https://doi.org/10.1007/s00268-018-4792-6

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  • DOI: https://doi.org/10.1007/s00268-018-4792-6

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